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Clin Med I-Cardiology > Cardiac > Flashcards

Cardiac Flashcards

1
Q

optimal way to obtain hemodynamics/ for vessels

A

angio

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2
Q

causes of AS

A

65: degeneration and sclerosis of valve

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3
Q

lab findings of AS

A

ECG: LVH, Increased QRS or just R amplitute
CXR: LVH, Ca deposit
Echo: immobile valves LVH

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4
Q

Findings of AS

A
  1. hyperdynamic LV
  2. soft/normal S1
  3. absent A2
  4. paradoxical splitting of the S2
  5. Ejection click
  6. prominent S4
  7. systolic murmur
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5
Q

st segment depression

A

myocardial hypoxia

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6
Q

indications for intervention of AS

A

sx: angina, syncope, dyspenia, chf
EF<50%
CAD with moderate AS
sever/critical AS

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7
Q

HCM

A

hypertrophic cardiomyopathy :subvalvular as

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8
Q

HCM

A

no calcification of av, murmur louder standing or valsalvaing , ejection sound uncommon, similiar sx to AS

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9
Q

tx of HCM

A

ca chan blocker, beta blocker

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10
Q

acute AR etiologies

A

aortic dissection, iatrogenic-cath/surgical, endocarditis

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11
Q

chronic AR etiologies

A
  1. rheumatic valve dz (~30%), bicuspid aortic valve, dilated aortic root, bacterial endocarditis, senile degeneration, connective tissue dz
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12
Q

RA, Marfans, ehlers-danlos may cause

A

AR

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13
Q

narrow PP

A

AS

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14
Q

wide PP (low diastolic)

A

AR

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15
Q

chronic AR results in

A

LV overload, dilation, hypertrophy, HF

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16
Q

acute AR results in

A

pulmonary edema

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17
Q

PE findings of AR

A

high pitched diastolic decescendo murmur at aortic are and left sternal border

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18
Q

austin flint murmur

A

low pitch diastolic murmur at the apex sounds like a diastolic mitral stenosis murmur

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19
Q

wide PP

A

increased systolic and decreased diastolic –>water hammer or corrigan pulse

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20
Q

Acute MR

A

papillary m. necrosis and rupture, endocarditis

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21
Q

marfans, graves dz, muscular dyst. a/w

A

barlows syndrome –>MR

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22
Q

Acute MR

A

papillary m. necrosis and rupture, endocarditis

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23
Q

marfans, graves dz, muscular dyst. a/w

A

barlows syndrome –>MR

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24
Q

MR RV failure signs

A

JVD, Hepatomegaly, edema

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25
Q

MR pulmonary HTN

A

s4 gallops, loud p2, rv heave and lift

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26
Q

most common cause of MS

A

rheumatic heart dz

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27
Q

emboli to the brain a/w

A

MS

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28
Q

most common cause of MS

A

rheumatic heart dz

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29
Q

anticoagulant

A

bleeding and thromboembolism

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30
Q

most common cause of hf

A

CAD

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31
Q

used to differentiate pulmonary from cardiac dz in pt w dyspnea and/or an inconclusive PE

A

BNP level

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32
Q

most common cause of hf

A

CAD

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33
Q

used to differentiate pulmonary from cardiac dz in pt w dyspnea and/or an inconclusive PE

A

BNP level

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34
Q

recommended initial therapy for ALL pt with HF

A

ACE inh., digoxin, diuretics

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35
Q

diastolic dysfunction is more common in

A

elderly female with HTN and DM

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36
Q

side effect of ACE

A

cough and renal dysfunction (okay)

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37
Q

ARBs (angiotensin-receptor blockers)

A

use if ACE not tolerated , assess bp, renal fxn, electrolytes regularly

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38
Q

digoxin

A

pt w a fib

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39
Q

indication of sporonolactone

A

pt with rest dyspnea within past 6 months, post MI with systolic dysfxn

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40
Q

digoxin

A

pt w a fib

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41
Q

PE sx

A

dyspnea, productive cough, diaphoresis

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42
Q

management of PE

A

O2, morphine, diuretics, nitrates

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43
Q

most common cause of HF is

A

left ventricular systolic dysfxn

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44
Q

side effect of statins

A

myopathy (check CK level), elevated LFTs

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45
Q

most common cause of HF is

A

left ventricular systolic dysfxn

46
Q

bile acid sequesterant contraindication

A

pt with hyperTAG

47
Q

side effect of nicotinic acid (niacin)

A

flushing due to increased prodtoglandin D2 production

48
Q

initial dx study for chest pain

A

ecg

49
Q

cardiac enzymes

A

CK, CKMB, Troponins

50
Q

initial dx study for chest pain

A

ecg

51
Q

cardiac enzymes

A

CK, CKMB, Troponins

52
Q

stress test drugs

A

adenosine, dipyridamole, dobutamine, isopproterenol

53
Q

absolute contraindication of exercise stress test

A

acute MI/ACS, acute myo/pericarditis, rapid a/v arrhythmias, sever AS, anemia, acute illness, infection, hyperthyroidism, acute aortic dissection

54
Q

in ex ekg looking for

A

st depression, increased hr, chest pain, sob, lightheadedness

55
Q

absolute contraindication of exercise stress test

A

acute MI/ACS, acute myo/pericarditis, rapid a/v arrhythmias, sever AS, anemia, acute illness, infection, hyperthyroidism, acute aortic dissection

56
Q

NMI

A

a perfusion defect is seen in areas of hypoperfusion

57
Q

indications of NMI

A

assess areas of ischemia, location and size of muscle after MI, dx narrowing of arteries, evaluate how grafted vessels work after CABG, evaluate effectiveness of balloon

58
Q

TEE can detect

A

clots, septal defect, PFO, ascending aortic atherosclerosis, aortic dissection, valvular pathologies, vegetation, better myocardial motion

59
Q

TTE for blood flow

A

color flow doppler technique

60
Q

TEE can detect

A

clots, septal defect, PFO, ascending aortic atherosclorosis, aortic dissection, valvular pathologies, vegetation, better myocardial motion

61
Q

cath/angio risk

A

bleeding, arrhythmias, vessel injury, post op bleeding, emboli, renal failure

62
Q

indications for cath/angio

A

known/suspected cad: unstable angina, angina, hx of MI, inadequate response to tx, post resuscitation from cardiac arrest,
atypical chest pain with high risk of cad, abnl LV fxn/LV failure
before valve surgery in pt with chest pain

63
Q

cath/angio risk

A

bleeding, arrhythmias, vessel injury, post op bleeding

64
Q

indications for cath/angio

A

known/suspected cad: unstable angina, angina, hx of MI, inadequate response to tx, post resuscitation from cardiac arrest,
atypical chest pain with high risk of cad, abnl LV fxn/LV failure
before valve surgery in pt with chest pain

65
Q

indication of holter

A

eval of syncope, palpitations, rhythm recording not good for infrequent , hr variability, st seg monitoring, detects silent ischemia

66
Q

implantable loop recorder useful in..

A

infrequent sx, suspected arrhythmia but invasive testing has been inconclusive

67
Q

risk factors for IHD

A

cocaine, DM1, hypercholestrolemia, FH

68
Q

atypical symptoms of myocardial ischemia

A

dyspnea, fatigue, nausea, faintness : most common in elderly and DM pts

69
Q

indication of holter

A

eval of syncope, palpitations, rhythm recording not good for infrequent , hr variability, st seg monitoring, detects silent ischemia

70
Q

implantable loop recorder useful in..

A

infrequent sx, suspected arrhythmia but invasive testing has been inconclusive

71
Q

CT indications

A

aortic disscection, coronary artery Ca deposition, atherosclerosis

72
Q

MRI indications

A

lengthy not good for ER

73
Q

risk factors for IHD

A

cocaine, DM1, hypercholestrolemia, FH

74
Q

atypical symptoms of myocardial ischemia

A

dyspnea, fatigue, nausea, faintness : most common in elderly and DM pts

75
Q

first line med for chronic angina

A

beta blockers

76
Q

beta blockers

A

decrease HR, BP, Contractility

77
Q

nitrates

A

reduce preload

78
Q

ca channel blockers

A

decrease BP, contractility, and act as coronary vasodilator

79
Q

ca channel blocker is indicate for pt who

A

dont respond to nitrates and beta blockers

80
Q

med increasing oxygen supply

A

nitrates and ca channel blockers

81
Q

anti platelet meds

A

aspirin and plavix or combination of both

82
Q

revascularization

A

PCI and CABG

83
Q

Tx of stable angina

A
  1. med to decrease oxygen demand
  2. med to increase oxygen supply
  3. anti platelet meds
  4. revascularization
84
Q

PCI

A

hx of angina despite medical tx, evidence of ischemia on stress testing, with or without stent placement

85
Q

CABG

A

left main coronary stenosis

triple vessel dz, use saphenous vein or internal mammary arteries

86
Q

atypical presentation of ACS in

A

elderly and DM

87
Q

atypical presentation of ACS

A

sudden breathlessness

88
Q

most common cause of ua/nstemi

A

plaque rupture or erosion with a superimposed nonocclusive thrombus

89
Q

dynamic obstruction

A

coronary a. spasm

90
Q

coronary a. spasm what angina

A

prinztmetal’s angina

91
Q

unstable angina

A

ischemic discomfort with at least one sx: occurs at rest lasting >10 min, sever and of new onset, with crescendo pattern

92
Q

troponin stays in blood up to

A

2 weeks

93
Q

ck-mb stays in blood up to

A

2 days

94
Q

unstable angina lab findings

A

no elevation of CK-MB or troponin-no myocardial necrosis

maybe ST depression or T wave inversion

95
Q

NSTEMI lab findings

A

definite elevation of CK-MB and/or troponin -actual infarct
no ST elevation
maybe ST depression or T wave inversion

96
Q

Tx of UA/NSTEMI

A

bed rest with cardiac monitoring and O2, nitrates, beta blockers, calcium channel blockers (if sx not relieved by beta blockers and nitrates), morphine (if symptoms not relieved by nitrates, anti thrombotic rx (aspirin, clopidogrel), anti coagulation with heparin, revascularization

97
Q

increased risk of STEMI in pt with

A

multiple risk factor and/or history of UA

98
Q

pathophysiology of STEMI

A

rupture of a vulnerable plaque in the setting of atherosclerotic coronary artery dz=> complete occlusion of coronary a. MOST COMMON ETIOLOGY

99
Q

precipitating factors for STEMI

A

vigorous exercise, emotional stress, medical/surgical illness/ within a few hrs of awakening in the morning

100
Q

Dx approach to suspected ACS

A

12 lead ECG, cardiac markers, cardiac imaging (2D echo to assess wall motion abnl), angio,CBC, lipids, CXR

101
Q

ST elevation with + enzymes

A

STEMI

102
Q

No ST elevation with + enzymes

A

NSTEMI

103
Q

-enzymes

A

UA

104
Q

ACS management

A

MONA= oxygen, nitroglycerin and morphine for pain, aspirin (antiplatelet therapy to limit size of infarct)

105
Q

Tx of STEMI

A

MONA, beta blockers-metoprolol, calcium channel blockers if sx are relieved by beta blockers and nitrates, morphine if sx not relieved by nitrate, anti thrombotic, anticoagulation w/heparin, anti arrhythmias, ace inhibitors, statins, REPERFUSION

106
Q

perfusion therapy

A

for STEMI, to limit size of infarct via 1. med with thrombolytic tx 2. PCI (angioplasty/stenting

107
Q

absolute contraindication of thrombolytic Tx

A

hx of cerebrovascular hemorrhage, hx of stroke in past yr, poorly controlled HTN, suspected aortic dissection, active internal bleeding

108
Q

no thrombolytics for

A

UA/NSTEMI

109
Q

Dressler’s syndrome

A

pericarditis= chest pain due to pericardial inflammation following MI, CABG, or trauma to heart
POST MI complications

110
Q

leading cause of inpatient death after MI

A

pump failure

111
Q

post MI med management

A

b blockers, aspirin, ARB or ACE-I if LV dysfunction

Clin Med I-Cardiology (1 decks)

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